Practitioner Rights
Practitioners have rights during the credentialing and recredentialing process and are notified of these rights through various means.
Practitioners have the right to:
- Credentialing and recredentialing decisions that are not based on the practitioner's race, ethnic/national identity, gender, age, sexual orientation or the types of procedures performed (provided such procedures are legal under US law) or patients in which the practitioner specializes. This includes information obtained from outside sources except for reports from the National Practitioner Databank.
- Review information the practitioner submitted to Moda Health to support their credentialing application.
- Correct erroneous information discovered during the verification process. The credentialing specialist will send three written requests with a 7-day deadline to allow the provider to clarify any discrepancy found. Contact information for the credentialing specialist will be provided at the time of the request.
- Request and be informed of the credentialing application status. The credentialing staff will respond to status requests within 2 weeks of receipt.
- Withdraw, in writing, the application at any time.
- Have the confidentiality of the application and all supporting documents protected and the information used for the sole purpose of application verification, peer review and panel participation decisions, subject to any disclosures required under state or federal law.
- Be notified of these rights.
- Participating providers have the right to appeal application denials and adverse action taken by Moda Health as outline in the Appeal of Moda Health Adverse Action.
Practitioners are notified of their rights in the Moda Health participating provider administrative manuals and the Moda Health website.
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